NEET MDS Lessons
General Pathology
Growth and spread of tumours
Growth in excess of normal is a feature of all tumours but extension to tissue away from the site of origin is a feature of malignant tumours.
Modes of spread of malignant tumours
- local, invasion. This is a feature of all malignant tumors and takes place along tissue spaces and facial planes
o Lymphatic spread. Most often seen in carcinomas. This can be in the form of
o Lymphatic permeation: Where the cells extend along the lymphatics as a solid core
o Lymphatic embolisation: Where a group of tumour cells break off and get carried to the draining mode
-Vascular spread : This is a common and early mode of spread for sarcomas but certain carcinomas like renal cell carcinoma and chorio carcinoma have a predilection to early vascular spread.
Vascular spread is most often due .to invasion of venous channels and can be by permeation or embolisation.
Lungs, liver, bones and brain are the common sites for vascular metastasis but
different tumours have different organ preference for metastasis, e.g. : Bronchogenic carcinoma often spreads to liver and adrenals.
-Body cavities and natural passages
o Gastrointestinal carcinomas spread to ovaries (Krukenberg’s tomour)
Osteonecrosis (Avascular Necrosis)
Ischemic necrosis with resultant bone infarction occurs mostly due to fracture or after corticosteroid use. Microscopically, dead bon trabevulae (characterized by empty lacunae) are interspersed with areas of fat necrosis.
The cortex is usually not affected because of collateral blood supply; in subchondral infarcts, the overlying articular cartilage also remains viable because the synovial fluid can provide nutritional support. With time, osteoclasts can resorb many of the necrotic bony trabeculae; any dead bone fragments that remain act as scaffolds for new bone formation, a process called creeping substitution.
Symptoms depend on the size and location of injury. Subchondral infarcts often collapse and can lead to severe osteoarthritis.
Histopathological techniques
Histopathological examination studies tissues under the microscope. During this study, the pathologist looks for abnormal structures in the tissue. Tissues for histopathological examination are obtained by biopsy. Biopsy is a tissue sample from a living person to identify the disease. Biopsy can be either incisional or excisional.
Once the tissue is removed from the patient, it has to be immediately fixed by putting it into adequate amount of 10% Formaldehyde (10% formalin) before sending it to the pathologist.
The purpose of fixation is:
1. to prevent autolysis and bacterial decomposition and putrefaction
2. to coagulate the tissue to prevent loss of easily diffusible substances
3. to fortify the tissue against the deleterious effects of the various stages in the preparation of sections and tissue processing.
4. to leave the tissues in a condition which facilitates differential staining with dyes and other reagents.
Hepatitis
Hepatitis viruses—this group of viruses causes hepatitis, a disease affecting the liver.
1. General characteristics of hepatitis.
a. The general presentation of hepatitis is the same regardless of the infecting virus; however, the time and severity of symptoms may differ.
b. Symptoms of hepatitis include fever, anorexia, malaise, nausea, jaundice, and brown-colored urine.
c. Complications of a hepatitis infection include cirrhosis, liver failure, and hepatorenal failure.
ATROPHY
It is the acquired decrease in the size of an organ due to decrease in the size and/or number of its constituent cells.
Causes:
(1) Physiological
- Foetal involution.
o Branchial clefts.
o Ductus arterious.
- Involution of thymus and other lymphoid organs in childhood and adolescence.
- In adults:
o Post-partum uterus.
o Post-menopausal ovaries and uterus
o Post-lactational breast
o Thymus.
(2) Pathological:
- Generalised as in
o Ageing.
o Severe starvation and cachexia
- Localised :
o Disuse atropy of bone and muscle.
o Ischaemic atrophy as in arteriosclerotic kidney. .
o Pressure atrophy due to tumours and of kidney in hydronephrosis.
o Lack of trophic stimulus to endocrines and gonads.
Autoimmune(acquired) Haemolytic anaemia
Auto antibodies are usually Ig g type (may be Ig M or Ig A). They may or may not bind complement and may be active in warm or cold temperature They may be complete (agggIutinating) or incomplete. Haemolysis s may be intravascular due to destruction of the antibody coated cells by RE system.
Causes:
a. Idiopathic
b. Secondary to
o Drugs - Methyldopa, Mefanamic acid
o Disease like
-> Infections especially viral.
-> Autoimmune disease especially SLE.
-> Lymphomas and chronic lymphatic leukaemia.
-> Tumours.
Diagnosis : is based on
• Evidences of haemolytic anaemia.
• Demonstration of antibodies
- On red cell surface by direct Coomb’s test
- In serum by indirect Coomb’s test.
CONGESTION
Congestion or hyperaemia means an increase in the content of blood in an organ. It may be :
A. Active - due to increased arterial flow to the organ with dilatation of micro vessels as in
- Inflammation.
- Increased metabolic activity.
- Neurogenic blushing.
B. Passive - due to decreased venous drainage resulting in pooling of blood. There is always an associated element of oedema.